Do not use codeine, tramadol in children: FDA

Codeine and tramadol should not be used to treat pain or cough in children younger than 12 years as they could be fatal, the Food and Drug Administration (FDA) said Thursday.

The FDA unveiled several changes to the labels of the medications to protect children, adolescents and infants being breastfed.

“We are requiring these changes because we know that some children who received codeine or tramadol have experienced life-threatening respiratory depression and death because they metabolize (or break down) these medicines much faster than usual (called ultra-rapid metabolism), causing dangerously high levels of active drug in their bodies,” Douglas Throckmorton, M.D., deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, said in a statement.

The FDA is adding the following new restrictions to the warning labels of codeine and tramadol:

  • Codeine is contraindicated to treat pain or cough, and tramadol is contraindicated for treating pain in children under 12.
  • Tramadol is contraindicated for treating pain after surgery to remove tonsils and/or adenoids for children under 18. Use of codeine for this purpose was placed under the same restriction in 2013.
  • Codeine and tramadol are not recommended for use in adolescents ages 12-18 who are obese or have conditions such as obstructive sleep apnea or severe lung disease.
  • Mothers should not breastfeed when taking codeine or tramadol.

Since 1969, codeine has been linked to 64 cases of serious breathing problems, including 24 deaths in children and adolescents. Tramadol is not approved for pediatric use but has been tied to nine cases of serious breathing problems, including three deaths in children and adolescents, according to the FDA. There also have been cases of breathing problems in breastfed infants whose mothers were taking codeine.

In September 2016, the Academy released a clinical report Codeine: Time to Say “No” that expressed concerns about the dangers of codeine use in children and called for more formal restrictions.

The FDA recommends physicians use other medications for treating cough and pain. Officials also encouraged parents to pay close attention to the ingredients in medication they give their children and seek immediate medical attention if children taking the restricted medications experience difficulty breathing, confusion, unusual sleepiness, trouble breastfeeding or limpness.

New Zika Videos for Pediatricians and Parents

The American Academy of Pediatrics (AAP) Disaster Preparedness Advisory Council (DPAC), in collaboration with the Centers for Disease Control and Prevention (CDC), recently released two videos, “Zika: Ten Tips for Pediatricians Supporting Families” and “Pediatrician Advice for Families: Responding to Your Concerns about Zika.”

Zika: Ten Tips for Pediatricians Supporting Families provides ten tips for pediatricians to consider when speaking with their patients who may have a child with Zika virus syndrome, or are worried about possible infection in their unborn child.

Pediatrician Advice for Families: Responding to Your Concerns about Zika provides expectant parents and their families with some basic information about the risks of Zika infection during pregnancy and recommends strategies to deal with stress if they are worried. Also addressed is what expectant parents can do or expect if Zika virus infection is suspected or known during pregnancy.

American Academy of Pediatrics staff members worked with DPAC member David Schonfeld, MD, FAAP, and Carolina Peña, MD, FAAP, to develop these videos to reinforce the need for education and outreach specific to Zika, and to fill the gap in psychosocial support resources for those caring for infants with congenital Zika virus syndrome.

These videos and many other Zika resources can be found on the AAP Zika Virus web pages, including the recent AAP webinar, “Zika, the Evolving Story: What You Need to Know” featuring Margaret (Peggy) Honein, PhD, MPH, CDC representative, Mark Hudak, MD, FAAP, and Shana Godfred-Cato, DO, FAAP. Visit these continually updated pages for the latest information and resources on Zika Virus.

Fetal Alcohol Spectrum Disorders (FASD) Toolkit

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The Fetal Alcohol Spectrum Disorders (FASD) Toolkit was developed to raise awareness, promote surveillance and screening, and ensure that all affected children receive appropriate and timely interventions.

View ToolKit >>

AAP names Jay C Butler, MD., C.P.E., FAAP of Anchorage Alaska to the National Vaccine Committee.

AAP named Jay C Butler, MD., C.P.E., FAAP of Anchorage Alaska to the National Vaccine Committee. Committee members provide peer review, consultation, advice and recommendations to the Assistant  Secretary for Health, who serves as the director of the National Vaccine Program. Dr. Butler is the chief medical officer for the Alaska Department of Health and Social Sciences and director of the Division of Public Health.  He is an affiliate professor of medicine at the University of Alaska Anchorage and President of the Association of State and Territorial Health Officials.

 

Congratulations Dr. Butler!

Bright Futures eNews – March 2017

 BRIGHT FUTURES eNEWS
March 2017
Dear Colleague,
We are pleased to announce the March 2017 installment of Bright Futures eNews.
If you are new to Bright Futures, watch this 2-minute About Bright Futures video to get started using the Bright Futures recommendations in your health promotion and disease prevention practices and with programs and families in your community.
Consider using the video in presentations about Bright Futures. Share the link with colleagues in various settings in which Bright Futures is being used (eg, clinics, home visiting, child care, school-based health centers, public health settings, etc.).
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition
Bright Futures Guidelines, 4th Edition is Released!
Do not miss the completely revised and updated 4th Edition of the Bright Futures Guidelines ! It is an essential resource that provides updated background and recommendations for pediatric health promotion and health supervision for 31 age-based visits – from infancy through adolescence. With Bright Futures, you can accomplish the following 4 tasks in 18 minutes — disease detection, disease prevention, health promotion, and anticipatory guidance! The result: more efficient visits, stronger partnerships with children and families, and greater knowledge of changes in family, communities, and society that affect a child’s health.
The Bright Futures Guidelines, 4th Edition builds upon previous editions with new and updated content that reflects the latest research. It includes 3 new health promotion themes (Promoting Lifelong Health for Families and Communities, Promoting Health for Children and Youth With Special Health Care Needs, Promoting the Healthy and Safe Use of Social Media), updated Milestones of Development and Developmental Surveillance questions, and new clinical content about the latest age-specific recommendations. Throughout, the Guidelines weave in recognition of social determinants of health (risks and protective factors) and an increased focus on lifelong physical and mental health.

As established in the 3rd Edition, the first priority for each health supervision visit is to address the needs and concerns of the child/adolescent and family, and the therapeutic relationship is key to implementation. Click here for a preview and for more infomation!

The Bright Futures Tool and Resource Kit is undergoing revision and is anticipated to be released in January 2018.

Introductory Webinars: Bright Futures Guidelines, 4th Edition
Make sure to sign up for the latest Bright Futures Webinars beginning in April 2017! Learn about the revised and updated Bright Futures Guidelines, 4th Edition from the editors themselves. We will be hosting two separate 45-minute Webinars for health care professionals and public health professionals. Of course, everyone is welcome to attend either! They will be recorded and posted on the Bright Futures Web site for anyone that cannot participate in the live events.
The editors will review the new and updated components such as 3 new health promotion themes, updated Milestones of Development and Developmental Surveillance questions, updates to several adolescent visit screening recommendations, and more. They will discuss how to efficiently and effectively integrate these new components into your practice setting and will answer your questions about the Bright Futures Guidelines, 4th Edition.
Bright Futures Guidelines, 4th Edition – Introduction (for Health Care Professionals)
Wednesday, April 19 
1:00 PM ET/12:00 PM CT
Click here to register.

Bright Futures Guidelines, 4th Edition – Introduction (for Public Health Professionals)
Wednesday, May 24 
1:00 PM ET/12:00 PM CT
Click here to register.
Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) 
Bright Futures/AAP Periodicity Schedule is Updated!
Each child and family is unique; therefore, the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (known as the Periodicity Schedule) are designed for the care of infants, children, and adolescents who are receiving competent parenting, have no manifestations of any important health problems, and are growing and developing in satisfactory fashion. Additional visits may become necessary if circumstances suggest variations from normal. Developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits.
The Bright Futures/AAP Periodicity Schedule is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence. These recommendations represent a consensus by the AAP and Bright Futures. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care. Refer to the specific guidance by age as listed in the Bright Futures Guidelines, 4th Edition.  For implementation and coding information for each visit on the Periodicity Schedule, please see the Bright Futures and Preventive Medicine Coding fact sheet. For more background, click here to review the related Bright Futures Guidelines, 4th Edition’s Evidence and Rationale chapter.
AAP Practice Transformation  is your one-stop resource for transforming your practice and career to meet the challenges of the new healthcare environment. Access the latest strategies, resources, and tools to make your practice thrive in the rapidly changing healthcare delivery and payment systems. Find practical guidance for all stages of your career. Be ready to face the future of pediatric practice.
Bright Futures Implementation
NEW State Implementation Stories!
Find out how your colleagues in other states are implementing the Bright Futures Guidelines by visiting the States & Communities section of the Bright Futures Web site. We have added 10 new and 5 updated implementation stories about states that are successfully implementing the Bright Futures recommendations. The new stories were developed as a part of the Alliance for Innovation on Maternal and Child Health project in which the AAP is participating. The stories were created by interviewing AAP chapter leaders and public health representatives. The stories demonstrate a wide variety of implementation examples including incorporating the Bright Futures/AAP Periodicity Schedule into Medicaid agencies, using Bright Futures measures in quality improvement projects, training multidisciplinary practitioners that provide services to families and children, and many other examples illustrating the value of flexibility of the Bright Futures content. Be sure to check-out the Bright Futures Web site for tips on implementing Bright Futures recommendations in your state, community, and practice.
Do you have a story to tell about how you’ve implemented Bright Future in your practice?
Please contact us so we can feature your implementation story on our Web site or in a future edition of the Bright Futures eNews.
Web site Contact Us: https://brightfutures.aap.org/Pages/contactus.aspx
Email: brightfutures@aap.org
Reminder: Please link directly to the Bright Futures/AAP Periodicity Schedule on your Web site to ensure you are accessing the most up-to-date version. Please check your current link and update accordingly.
Be sure to visit the Bright Futures Web site to access Bright Futures materials and other resources.
Inclusion in this publication does not imply an endorsement by the American Academy of Pediatrics. The AAP is not responsible for the content of these resources. Web site addresses are as current as possible but may change at any time. The American Academy of Pediatrics Bright Futures National Center eNews is funded through a cooperative agreement (grant number: U04MC07853) with the Health Resources and Services Administration, Maternal and Child Health Bureau.

Contact brightfutures@aap.org for more information.

American Academy of Pediatrics 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098

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GOP health-care plan: Don’t gut Medicaid

As a primary-care pediatrician, I greatly appreciated Bob Young’s summary of the GOP health-care plan.

There is little surprise their proposed plans include eliminating Medicaid expansion and the individual mandate. However, the House bill also proposes radical decreases to Medicaid funding.

Medicaid is an American legislative success story. It came into law with bipartisan support, and 95 percent of kids nationwide have health insurance coverage largely thanks to Medicaid. In Washington state, one out of every two kids is insured by Medicaid. In my own practice, a sizable percentage of kids are insured through Medicaid.

I am certain that the electorate did not intend for the federal government to gut Medicaid, taking us far backward in providing medical coverage for Washington children.

Rupin Thakkar, M.D., Seattle

What’s the Latest with the Flu for Clinicians – March 2017

American Academy of Pediatrics
What’s the Latest with the Flu for Clinicians
March 2017

 

Current Flu Situation

As of March 7, flu activity was still elevated in the United States and expected to continue for several weeks. The season so far has been moderate. The majority of states reported widespread influenza activity at this time. With 40 pediatric deaths from influenza reported so far this flu season, even one preventable death is too many. Flu-related deaths in children younger than 18 years old should be reported through the Influenza-Associated Pediatric Mortality Surveillance System. The number of flu-associated deaths among children reported during this 2016-2017 flu season will be updated each week and can be found at www.cdc.gov/flu/weekly.

It is important to continue to recommend influenza vaccination. Children 6 months through 8

years of age need 2 doses if they have received fewer than 2 doses of any trivalent or quadrivalent influenza vaccine before July 1, 2016. The interval between the 2 doses should be at least 4 weeks. This age cohort requires only 1 dose if these children have previously received 2 or more total doses of any trivalent or quadrivalent influenza vaccine before July 1, 2016. The 2 previous doses do not need to have been received during the same influenza season or in consecutive influenza seasons. See the American Academy of Pediatrics (AAP) policy, “Recommendations for Prevention and Control of Influenza in Children, 2016–2017”, for more information.

The Centers for Disease Control and Prevention (CDC) released a new Morbidity and Mortality Weekly Report (MMWR) titled, “Update: Influenza Activity — United States, October 2, 2016–February 4, 2017.” The report summarizes U.S. influenza activity for the dates listed.

 

More Influenza Illness Suggests Need for More Rapid Antiviral Treatment

Children clinically presumed to have influenza should be considered for early antiviral treatment, when indicated, independent of laboratory confirmation or receipt of influenza vaccine. This crucial approach can help minimize morbidity and mortality, particularly in young children, and those who are hospitalized or who have underlying co-morbidities. Antiviral treatment should be started as soon as possible after influenza illness onset and should not be delayed while waiting for a confirmatory test result because early therapy provides the best outcomes.

Treating high risk children or children who are very sick with flu with antiviral drugs is very important. It can mean the difference between having a milder illness instead of a very serious one that could result in a hospital stay. See the AAP policy or visit the CDC Antiviral Drugs Web page for information about how antiviral medications can be used to prevent or treat influenza when influenza activity is present in the community. A summary of antiviral recommendations for clinicians is available on the CDC Web page Influenza Antiviral Medications: Summary for Clinicians.

CDC Webinar: 2016-2017 Influenza Season Activity and Recommendations for Clinicians

On February 16, 2017, the CDC Clinician Outreach and Communication Activity (COCA) hosted a webinar titled “2016-2017 Influenza Season Activity and Recommendations for Clinicians.” During this webinar, clinicians learned about 2016-2017 influenza activity to date and heard an overview of CDC recommendations for health care providers including influenza vaccination and the use of antiviral medications for the treatment of influenza. An archived version of the webinar, a transcript, and presentation materials are available online.

 

Ready Wrigley Preparedness for Flu Season

The AAP worked with the CDC to develop and endorse a new Ready Wrigley Activity Booklet on influenza. Each book aims to build capacity in children’s preparedness by inspiring youth readiness and promoting individual resilience. The books are designed for children 2 to 8 years of age. The Ready Wrigley Activity Book series is produced by the CDC Children’s Preparedness Unit and CDC communication specialists.

 

Additional Information

For more information, see the AAP Red Book Online Influenza Resource page and CDC FluView. All AAP “What’s the Latest with the Flu” messages are archived. Members of the AAP also have access to Flu Vaccine Recommendations and Key Speaking Points.